سهم نسبی باورهای فراشناختی و کنترل توجه از نظر شدت قمار در قماربازان

Abstract The present study explored the relationship between metacognitions, attentional control, and the severity of gambling in problem gamblers. One hundred and twenty six problem gamblers completed the Depression Anxiety Stress Scales 21, the Meta-Cognitions Questionnaire 30, the Attentional Control Scale, and the Problem Gambling Severity Index. Results revealed that negative affect, four out of five metacognitions factors (positive beliefs about worry, negative beliefs about thoughts concerning danger and uncontrollability, cognitive confidence and beliefs about the need to control thoughts), and all attentional control factors (focusing, shifting and flexible control of thought) were correlated, in the predicted directions, with the severity of gambling. The same metacognitions were also found to be correlated, in the predicted directions, with attention focusing, however only negative beliefs about thoughts concerning danger and uncontrollability and cognitive confidence were found to be correlated with attention shifting and flexible control of thought. A hierarchical regression analysis showed that beliefs about the need to control thoughts were the only predictor of the severity of gambling controlling for negative affect. Overall these findings support the hypotheses and are consistent with the metacognitive model of psychological dysfunction. The implications of these findings are discussed

. Introduction Problem gambling has far reaching effects on numerous areas of an individual's life, including health, relationships with family and friends, and financial stability. Problem gambling has also been associated with alcoholism and drug use, depression and suicidal tendencies, and criminal behaviour (Morasco et al., 2006 and Petry et al., 2005). Cognitive behavioural therapy (CBT) has been used as the first line of treatment for problem gambling with a primary focus upon the restructuring of the content of thinking, such as tackling irrational beliefs and attitudes relating to gambling, which have been shown to be central in the development and maintenance of gambling problems (Gaboury and Ladouceur, 1989, Sharpe, 2002 and Toneatto, 1999). There is evidence supporting CBT for problem gambling (Toneatto, 2005 and Toneatto and Millar, 2004), however improvements appear to only occur in the short-term with relapse rates remaining high (Cowlishaw et al., 2012 and Toneatto et al., 2007). A fundamental limitation of CBT is its almost exclusive focus on targeting the content of thoughts at the detriment of not fully addressing other crucial components of cognition involved in the maintenance of psychological dysfunction. As Wells and Matthews (1996) state “cognitive theories of emotional disorder tend to consider only limited elements of cognition, and they often neglect broader aspects such as attention, regulation of cognition, levels of control of processing, and interactions between varieties of processing” (p.881). Twenty years ago Wells and Matthews (1994) put forward the Self-Regulatory Executive Function (S-REF) model with the specific aim of addressing how multiple levels of cognition (i.e. metacognition) are involved in the development and maintenance of psychological dysfunction. Over the last two decades the S-REF model has led to the development of disorder-specific formulations and treatments for a wide array of psychological disorders and a psychological treatment, metacognitive therapy (MCT), which has been evaluated across a series of studies with preliminary results indicating superior outcomes to CBT (Normann et al., 2014, Wells, 2009 and Wells, 2013). In the S-REF model, Wells and Matthews, 1994 and Wells and Matthews, 1996 argue that psychological dysfunction is associated with a style of thinking termed the Cognitive Attentional Syndrome (CAS) which consists of heightened self-focused attention, recyclical thinking patterns (rumination and worry), avoidance and thought suppression, and threat monitoring. The activation and persistence of the CAS in response to stress are dependent on maladaptive metacognitions. Metacognitions refer to the information individuals hold about their own cognition and internal states, and about coping strategies that impact on both (Wells, 2000; Wells and Matthews, 1994 and Wells and Matthews, 1996). Examples of information individuals hold about their own cognition may include beliefs concerning the significance of particular types of thoughts, e.g. “It is bad to think X” or “I need to control thought X”. Examples of information individuals hold about coping strategies that impact on cognition may include beliefs such as “Worrying will help me get things sorted out in my mind” or “Ruminating will help me solve the problem”.

Results 6.1. Data description Descriptive statistics for all the study variables are presented in Table 1. An inspection of skewness coefficients and levels of significance on Kolmogorov–Smirnov tests indicated that several measures were not normally distributed. Spearman's rho correlations revealed that negative affect, four out of five metacognitions factors (positive beliefs about worry, negative beliefs about thoughts concerning danger and uncontrollability, cognitive confidence, and beliefs about the need to control thoughts) and all attentional control factors (focusing, shifting and flexible control of thought) were correlated, in the predicted directions, with severity of gambling. These same metacognitions were also found to be correlated, in the predicted directions, with attention focusing, however only negative beliefs about thoughts concerning danger and uncontrollability and cognitive confidence were found to be correlated with attention shifting and flexible control of thought. Table 1. Means, standard deviations, ranges and Spearman rho inter-correlations of variables. X SD Range MCQ-30-PBW MCQ-30-NBT MCQ-30-CC MCQ-30-BNT MCQ-30-CS ACS-F ACS-S ACS-FCT PGSI 1. DASS-21 9.8 7.5 0–30 0.35⁎⁎ 0.57⁎⁎ 0.20⁎ 0.31⁎⁎ 0.27⁎⁎ − 0.38⁎⁎ − 0.30⁎⁎ − 0.34⁎⁎ 0.35⁎⁎ 2. MCQ-30-PBW 9.6 3.9 6–24 – 0.56⁎⁎ 0.21⁎ 0.29⁎⁎ 0.25⁎⁎ − 0.26⁎⁎ − 0.13 − 0.13 0.35⁎⁎ 3. MCQ-30-NBT 10.1 4.1 6–24 – – 0.26⁎⁎ 0.46⁎⁎ 0.33⁎⁎ − 0.31⁎⁎ − 0.27⁎⁎ − 0.21⁎ 0.37⁎⁎ 4. MCQ-30-CC 10.0 4.0 6–24 – – – 0.17 0.14 − 0.23⁎⁎ − 0.19⁎ 0.26⁎⁎ 0.18⁎ 5. MCQ-30-BNCT 11.0 3.9 6–24 – – – – 0.47⁎⁎ − 0.37⁎⁎ − 0.04 − 0.17 0.42⁎⁎ 6. MCQ-30-CS 14.3 4.9 6–24 – – – – – − 0.10 0.11 0.13 0.08 7. ACS-F 24.0 4.5 11–35 – – – – – – 0.44⁎⁎ 0.32⁎⁎ − 0.34⁎⁎ 8. ACS-S 18.3 3.6 8–28 – – – – – – – 0.52⁎⁎ − 0.22⁎ 9. ACS-FCT 11.9 2.1 7–16 – – – – – – – – − 0.26⁎⁎ Note. n = 126. DASS-21 = Depression Anxiety and Stress Scales 21; MCQ-30-PBW = Metacognitions Questionnaire 30-Positive Beliefs about Worry; MCQ-30-NBT = Metacognitions Questionnaire 30-Negative Beliefs about Thoughts; MCQ-30-CC = Metacognitions Questionnaire 30-Cognitive Confidence; MCQ-30-BNCT = Metacognitions Questionnaire 30-Beliefs about the Need to Control Thoughts; MCQ-30-CS = Metacognitions Questionnaire 30-Cognitive Self-consciousness; ACS-F = Attentional Control Scale-Focusing; ACS-S = Attentional Control Scale-Shift; ACS-FCT = Attentional Control Scale-Flexible control of thought; PGSI = Problem Gambling Severity Index. ⁎ p < .05. ⁎⁎ p < .01. Table options 6.2. Hierarchical regression analysis In relation to the assumptions relevant to running a hierarchical regression analysis, no evidence of multicollinearity in the dataset was observed (no correlations greater than r = 0.9, no Tolerance Indexes below 0.10, and all Variance Inflation Factors of less than 10). Additionally, the Durbin–Watson test suggested that the assumption of independent errors was tenable. Histograms and normality plots indicated that residuals were normally distributed and plots of the regression-standardized residuals against the regression standardized predicted values suggested that the assumptions of linearity and homoscedasticity were met. To evaluate whether metacognitions and attentional control independently predicted the severity of gambling, a hierarchical regression analysis (see Table 2) was run with all variables found to be significant in the correlation analysis. Negative affect was entered on step 1, the four metacognitions factors were entered on step 2, and all three attention control factors were entered on step 3. The final equation showed that beliefs about the need to control thoughts were the only independent and significant predictor of severity of gambling. Table 2. Hierarchical multiple linear regression statistics with problem gambling severity as outcome variable and metacognitions and attentional control as predictor variables. 95% confidence interval Predictor R2 β t p LL UL Step 1 DASS-21 0.45 5.60 .01 0.10 0.20 0.20⁎⁎ Step 2 DASS-21 0.23 2.20 .03 0.01 0.14 MCQ-30-PBW 0.04 0.45 .65 − 0.08 0.13 MCQ-30-NBT 0.09 0.72 .48 − 0.09 0.20 MCQ-30-CC 0.14 1.77 .08 − 0.01 0.18 MCQ-30-BNCT 0.26 2.82 .01 0.05 0.28 0.31⁎⁎ Step 3 DASS-21 0.18 1.60 .11 − 0.01 0.13 MCQ-30-PBW 0.04 0.46 .65 − 0.08 0.13 MCQ-30-NBT 0.07 0.51 .61 − 0.11 0.19 MCQ-30-CC 0.11 1.30 .20 − 0.03 0.16 MCQ-30-BNCT 0.26 2.65 .01 0.04 0.28 AC-F − 0.09 − 0.92 .36 − 0.15 0.06 AC-S − 0.09 − 0.94 .35 − 0.20 0.07 AC-FCT 0.03 − 0.28 .78 − 0.26 0.19 0.33 Note. n = 126. DASS-21 = Depression Anxiety and Stress Scales 21; MCQ-30-PBW = Metacognitions Questionnaire 30-Positive Beliefs about Worry; MCQ-30-NBT = Metacognitions Questionnaire 30-Negative Beliefs about Thoughts; MCQ-30-CC = Metacognitions Questionnaire 30-Cognitive Confidence; MCQ-30-BNCT = Metacognitions Questionnaire 30-Beliefs about the Need to Control Thoughts; ACS-F = Attentional Control Scale-Focusing; ACS-S = Attentional Control Scale-Shift; ACS-FCT = Attentional Control Scale-Flexible control of thought. ⁎ p < .05. ⁎⁎ p < .01.